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Role of 99mTc Sestamibi Scintimammography for the Evaluation of Breast
Published in Raymond Taillefer, Iraj Khalkhali, Alan D. Waxman, Hans J. Biersack, Radionuclide Imaging of the Breast, 2021
Iraj Khalkhali, Jorge Tolmos, Linda Diggles
Clinical evaluation of axillary-node involvement has a high false-positive and false-negative rate. Histological evaluation of the axillary specimen is the gold standard for the assessment of axillary metastasis. Axillary dissection offers no therapeutic benefit to node-negative patients, and it may lead to unnecessary morbidity. The most frequent complications following axillary dissection are wound seroma and infection [95]. Long-term morbidity from axillary node dissection occurs less commonly but may be a source for persistent complaints: mild to severe impairment of arm motion, lymphedema, sensory deficit caused by transection of the intercostobrachial nerves. A further reduction of the morbidity rates by selectively identifying patients who may exhibit a more significant benefit from axillary dissection should be taken into account to preserve an optimal quality of life [96].
Breast cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Axillary dissection is a more extensive surgical procedure comprising the removal of the axillary contents at least up to the level of the upper border of the pectoralis minor muscle (level 2) or even axillary vein (level 3). Twenty to thirty nodes may be retrieved by the pathologist, giving more detailed prognostic information. It also has the advantage of being a one-stop therapeutic manoeuvre in its own right, lessening the risk of axillary recurrence. It has the disadvantage of increasing the surgical morbidity, resulting in local sensory loss, stiffness of the shoulder and a risk of lymphoedema of the ipsilateral arm.
Lymph Stasis After Lymph Node Dissection
Published in Waldemar L. Olszewski, Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
Terence P. Wade, Michael T. Lotze
Lymphedema of the arm after mastectomy and axillary dissection is reported as less than 10% in most series,7 and is fortunately most often mild and decreasing in incidence. Radical mastectomy (which is now less commonly performed) was associated with a higher incidence of severe lymphedema. The addition of radiation therapy to the dissected axilla is often a marked aggravating factor,8 as is wound infection after operation. The discussion of lymphedema after mastectomy would not be complete without mention of lymphangio-sarcoma in the extremity chronically edematous after nodal dissection. First described by Stewart and Treves in 1948,9 the complication is seen an average of 10 years after mastectomy and is difficult to treat and harder to cure.10 Fortunately, with the decreased performance of radical mastectomy in the last 20 years, the incidence of this problem has also decreased.
Sentinel Node Mapping at the Time of COVID-19 Outbreak
Published in Journal of Investigative Surgery, 2022
Chiara Listorti, Giorgio Bogani, Francesco Raspagliesi, Secondo Folli
The current ongoing COVID-19 outbreak is changing our practice as COVID-19 threatens to curtail patient access to evidence-based treatment.8–14 Reducing the in-hospital risk of COVID-19 transmission is a priority. In the paper published in this issue,15 the authors evaluated the impact of not performing delayed lymphoscintigraphic images for minimizing the in-hospital waiting time. The authors compared outcomes of 74 and 73 patients managed before and during the COVID-19 outbreak, respectively. All patients underwent sentinel node mapping for early-stage breast cancer: the 74 patients having treatments before the pandemic had lymphoscintigraphy with the evaluation of both the early and delayed images, while the 73 patients having treatment during the pandemic had early images only. Sentinel nodes were more likely to be detected in patients having both early and late images available, although there was not a statistically significant difference. Owing to the failure of sentinel node identification, axillary dissection was performed in two (2.7%) and seven (9.6%) patients in the pre-pandemic and pandemic period, respectively.15 Authors discuss that the percentage of sentinel node identification might have been higher if delayed images could have been taken, therefore performing fewer axillary dissections. The paper raises a question on the consequences of shortening the in-hospital waiting time, when reducing this time could potentially have an impact on the standard of care of axillary staging.
The Effects of Modified Lymphoscintigraphy Techniques on Sentinel Lymph Node Biopsy Success During the COVID-19 Pandemic Period
Published in Journal of Investigative Surgery, 2022
Cemil Yüksel, Serdar Çulcu, Lütfi Doğan
Sentinel lymph node biopsy (SLNB) has replaced routine axillary dissection in early-stage breast cancer since the late 1990s [1–3]. Sampling of the sentinel lymph node (SLN) in breast cancer provides accurate information about the condition of the axilla in 95% of cases [4]. Technically in detecting SLN; radioactive substance, dyers or both are used. Sentinel nodes detected by scintigraphic imaging during the preoperative period can be found with the help of gamma probe and/or after the injection of dyers to the breast during surgery, the stained duct in the axilla and subsequently the dyed lymph node can be observed and surgically removed. There are different applications regarding issues such as the choice of agents to be used (blue dye, radioactive substance, or both), the location of injection (periareolar, subareolar, peritumoral), and timing of scintigraphy (morning of surgery or the day before).
Role of Intraoperative Nerve Monitoring in Postoperative Muscle and Nerve Function of Patients Undergoing Modified Radical Mastectomy
Published in Journal of Investigative Surgery, 2021
Serhat Tokgöz, Ebru Karaca Umay, Kerim Bora Yilmaz, Muzaffer Akkoca, Melih Akinci, Cem Azili, Mehmet Saydam, Yasin Ucar, Şener Balas
A total of 22 patients who underwent MRM at the Breast Surgery Unit of our hospital were included in the study after the necessary ethics committee approvals and patient consents were obtained (approval no. 51-08). Patients who underwent breast-conserving surgery and patients for whom axillary dissection had been chosen according to sentinel lymph node biopsy results were excluded from the study. In 11 patients included in the study, the LPN, MPN, TLN, and TDN were identified and protected by nerve monitoring during the axillary dissection (IONM group). In another 11 patients, nerve monitoring was not performed; however, protection of the same nerves was attempted through careful nerve dissection with the technique described below (CND group). In addition to the study patients, 22 patients with no previous breast surgery, no active symptoms related to the anterior chest and arm, and no cervical neuropathy were included as the control group. The pectoralis minor muscle (PMM) was preserved and a standard Level II axillary dissection was performed. Patients with nerve injury detected preoperatively, with nerve invasion, who underwent Level III axillary dissection, or who underwent PMM resection were excluded from the study.